Advanced Lateral Ankle Sprain Exercises And Interventions

This article will cover advanced lateral ankle sprain exercises and interventions. We have written a previous ankle prehab article on how to prehab your ankles and initially manage a lateral ankle sprain. However, how do you get the ankle back to 100%? What exercises should you include in the athlete’s training sessions to best prepare them for returning to play? What can clinicians do hands-on to rehab and help support a lateral ankle sprain? Read more to find out!

Y-Balance

The Y-Balance exercise comes from the Star Excursion Balance Test (SEBT), which is a common functional test to examine dynamic ankle stability. Functional tests themselves can become interventions and exercises, thus you have the Y-Balance exercise! Functional tests are important to perform because they provide a format to communicate an individual’s current functional capacity. Functional tests also help to determine a starting point and track progress towards return to sport participation. You can click here to learn more about the SEBT.

One of my favorite sayings is – you cannot track progress without measuring change

The Y-Balance exercise is a dynamic single leg exercise that works on balance, proprioception, and strength. Depending on the direction you reach, the ankle joint will have to move through varying positions of ankle dorsiflexion, pronation, and supination. Deceleration of joint motions is so important to train when recovering from an injury to mitigate the risk of re-injury or secondary injury. As much as this exercise can be a starting point for individuals recovering from a lateral ankle sprain, there are ways to ramp it up to add it to the list of advanced lateral ankle sprain exercises.

Here is an article that suggests poor performance on the SEBT can predict lower extremity injury risk.

Adding an unstable surface to the Y-Balance is one simple way to make this exercise more challenging. Unstable surface training has received a lot of criticism about whether it actually improves performance, and whether or not it is a waste of time including this training for individuals. There is also mixed evidence when examining the benefits of unstable surface training with results in-favor and against this type of training. HOWEVER, with that being said unstable surface training has its place to help an individual improve their balance and proprioception. When programmed APPROPRIATELY in an individuals rehab and strengthening and conditioning program, it can help an individual get back to doing the things they love to do!

If you don’t like unstable surfaces, you can add other components to the Y-Balance to add it to the list of advanced lateral ankle sprain exercises including…

Eyes closed

Increase/decrease speed of movement

Add external load (weight in either hand)

manual perturbations

Advanced Calf Strengthening

Here is one of my favorite squat variations to target the calves and dynamic ankle stability. I typically add this once an individual feels comfortable with heel raises standing and heel raises in a squatted position. I also like to program this with side steps on toes. Definitely add this to the list of advanced lateral ankle sprain exercises!

Want to find more videos like this? Click here and use the ‘foot/ankle/toe’ tag under Body part/joint tab to see more!

Single Leg Balance With Ankle Inversion

“You didn’t get hurt on the table, you’re likely not going to get better on the table” -IKN

This is one of my go-to advanced lateral ankle sprain exercises. Training positions of vulnerability is important for a few reasons…

It is important to be able to tolerate and CONTROL these positions

It is important to regain CONFIDENCE in these positions

It is important to practice multi-tasking (sport specific movements) in these positions

Often there is a lot of time spent avoiding and minimizing these vulnerable positions. However, it is imperative that an individual has the ability to decelerate and control positions of vulnerability. This principle can be applied to other injuries such as an ACL – decelerating dynamic knee valgus should be a major focus in ACL prehab and rehab!

Forward & Lateral Bosu Lunges With Single Leg Balance

This is on the list of advanced lateral ankle sprain exercises for a few reasons…

Promotes dynamic ankle and lower body stability

Promotes learning deceleration

Promotes speed and muscular power by practicing a powerful dynamic push-off

Promotes confidence in the sprained ankle

Should you and can you do this on both sides?! Absolutely!

Lateral Hop & Stick

Lets breakdown what is the most important movement an individual needs to CONTROL after a lateral ankle sprain… lateral movements! When you move laterally (if it is your right ankle -> moving to your right) the ankle has to decelerate an external inversion force to maintain contact with the ground. If you were to hop to your right and loss your balance to the right, your big toe as well as the medial side of your foot would come off the ground positioning your ankle into inversion. When the time is right, I have every individual that has experienced a lateral ankle sprain perform this exercise.

You can make this exercise easier or harder! It doesn’t have to look like this…

Remove the bosu, decrease the distance covered, provide upper body support, you decide! Yes these are advanced lateral ankle sprain exercises, however you can modify and regress everything shown thus far to challenge the sprained ankle appropriately! The beauty of all these advanced lateral ankle sprain exercises is that you can alter them however you’d like!

Hands-on Techniques

Ankle Rhythmic Stabilization

Working ankle stability is key following a lateral ankle sprain. With repeated lateral ankle sprain cases, the concern for Chronic Ankle Instability (CAI) increases. There are great partner exercises for soccer players that target the hamstrings (Nordic Hamstring Curl) and adductors (Copenhagen Adduction), what about the ankle?!

Here is a PNF Rhythmic Stabilization exercise designed for the ankle that I use with athletes. Notice I have the patient close his eyes here to really focus on stabilizing his ankle. I think as PTs and other clinicians we do a great job utilizing hands-on Proprioceptive Neuromuscular Facilitation (PNF) techniques for regions like the shoulder, but why not use them for other regions like the ankle?!

I think this is a great exercise teammates could add to their strengthening and conditioning programs. I like to program it with 3 to 4 sets of 15-30 seconds matching the individual’s resistance. It is important to not overpower the individual’s ankle and make it move too much! Also don’t feel limited to this position, however I like this position because it allows you to stabilize the person’s leg and not let them cheat.

Lateral Ankle Stability Tape Technique

Why tape? Tape can help with pain mitigation and neurosensory input.

After an injury such as an ankle sprain, people tend to deal with a lot of pain. Pain can interfere with the mind-body connection leading to abnormal movement patterns. Tape can help with the connection and perception of movement between our brain and our body, which can help with pain and ultimately help people move better! Demonstrated in this video is a lateral ankle stability tape technique using Cover-Roll and Leukotape.

Is the tape keeping the ankle in place and limiting motion? – NO

Be sure to watch and listen to the entire video as I talk about what the tape job does/does not do and why I choose the angles and anchors that I did. In short – the tape is giving the individual FEEDBACK as to what position his ankle is moving into. The skin is one of the largest, if not the largest, organ in our body. Sensory fibers are the fastest fibers in the body – tapping into this system can potentially improve that mind-body connection we spoke of earlier, which can tell the individual exactly where their ankle is in relation to space EARLIER than it would without tape. As we know, ankle sprains can lead to proprioception deficits up to a YEAR, why wouldn’t you want to consider giving the ankle more input and feedback?

Could it simply be placebo? Yes, however we know in sports there are a lot of things that are placebo (simply a person doing the same exact warm-up routine a certain way) that the athlete swears it improves their performance. In this case, the athlete felt less pain and more confident with his ankle and his ability to play soccer after I tapped it. Will I continue to tape it long-term? No, but for short-term if it helps to get my athlete back on the field sooner I will do it!